Healthcare Provider Details

I. General information

NPI: 1568892073
Provider Name (Legal Business Name): JULIE JACKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE JACKSON NP

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF CINCINNATI ACADEMIC HEALTH CTR 231 ALBERT SABIN WAY, SUITE 1358
CINCINNATI OH
45267-0769
US

IV. Provider business mailing address

UNIVERSITY OF CINCINNATI ACADEMIC HEALTH CTR 231 ALBERT SABIN WAY, SUITE 1358
CINCINNATI OH
45267-0769
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-8090
  • Fax:
Mailing address:
  • Phone: 513-558-8090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.14836-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: